The Madagascar periwinkle [Catharanthus roseus (L.) G. Don] is a plant species known for its production of TIAs (terpenoid indole alkaloids), many of which are pharmaceutically important. Ajmalicine and serpentine are prescribed for the treatment of hypertension, whereas the bisindoles vinblastine, vincristine and 3',4'-anhydrovinblastine are used for their antineoplastic activity in the treatment of many cancers. However, TIAs are produced in small yields in C. roseus, which make them expensive. Cell and metabolic engineering has focused on increasing flux through the TIA pathway by various means, including optimization of medium composition, elicitation, construction of noval culture systems and introduction of genes encoding specific metabolic enzymes into the C. roseus genome. The present review will attempt to present the state-of-the-art of research in this area and provide an update on the cell and metabolic engineering of TIAs in C. roseus. We hope that this will contribute to a better understanding of the ways in which TIA production can be achieved in different C. roseus culture systems.